Subject

Mr Beach complains that the Authority have incorrectly refused him an injury award from the Scheme.

The Pensions Ombudsman’s determination and short reasons

The complaint should be upheld against the Authority because they relied on a flawed report by the Independent Qualified Medical Practitioner (IQMP).  The basis on which permanent disability was assessed was unclear and the report referred to possible treatments without describing the likelihood of their success.

Complaint summary

Mr McSorley’s complaint about the NIPB, the scheme manager, is that he is not being paid the correct percentage of disablement pension and that the correct percentage should be backdated to 2005, when he first started to receive an injury benefit.

Summary of the Ombudsman’s determination and reasons

The complaint should partly upheld against NIPB because even though they did not deal with Mr McSorley’s original appeal in accordance with the regulations, they did so when they dealt with his second appeal.

Complaint Summary

Mr Kilgallon has complained about the way WYPA handled his claim for an injury benefit. He says that they unlawfully reduced his injury benefit based on a flawed Home Office circular 46/2004 for a period of 12 months. He complains about the way WYPA implemented the reduction. He also says that they have not offered him adequate compensation for the distress and inconvenience caused to him by their error and for the costs he has incurred in pursuing his complaint.

Complaint summary

Ms Mureph has complained that her eligibility for a permanent injury benefit (PIB) has not been considered in a proper manner.

Summary of the Ombudsman’s determination and reasons

The complaint should be upheld against the NHS BSA because they did not give due consideration to the contribution Ms Mureph’s NHS employment made to her back condition.

Complaint summary

Mrs Webb has complained that NHSBSA have refused to award her a Permanent Injury Benefit (PIB).

Summary of the Ombudsman’s determination and reasons

The complaint should be upheld against NHSBSA because they have not properly considered whether Mrs Webb’s Fibromyalgia has caused her a Permanent Loss of Earnings Ability (PLOEA).

Complaint summary

Mr Lee has complained that a reduction has been applied to his Permanent Injury Allowance (PIA); he also disagrees with the decision not to allow him a second appeal against the reduction applied to his PIA under the Scheme.

Summary of the Ombudsman’s Determination and reasons

The complaint should not be upheld against GAD because they had no involvement in the decision to reduce Mr Lee’s PIA or in the administration of the appeal.

Complaint summary

Mr X has complained that the NIPB have refused to refer his case for review under regulation 31(2) of the Police Service of Northern Ireland and Police Service of Northern Ireland Reserve (Injury Benefit) Regulations 2006.

Summary of the Ombudsman’s determination and reasons

The complaint should be upheld against the NIPB because they have failed to take steps to establish whether or not Mr X is in receipt of the correct level of benefit.

Ombudsman’s Determination

Outcome

Dr R’s complaint is upheld and to put matters right NHS BSA shall within 7 days of the date of this Determination pay Dr R £500 for distress and inconvenience caused and within 28 days reconsider Dr R’s application for a Permanent Injury Benefit (PIB).

My reasons for reaching this decision are explained in more detail below.

Complaint summary

Dr R’s complaint is that he has been incorrectly refused a PIB.

Among other things, Gordons Partnership (who are representing Dr R) say:

Ombudsman’s Determination

Outcome

Mr S’ complaint is upheld and to put matters right the Service shall consider wholly afresh whether Mr S is entitled to an injury award and pay Mr S £500 for the significant distress and inconvenience caused.

My reasons for reaching this decision are explained in more detail below.

Complaint summary

Mr S’ complaint is that he has been refused an injury award.

Ombudsman’s Determination

Outcome

Ms E’s complaint against Thames Valley Police is partly upheld, but there is a part of the complaint I do not agree with. To put matters right (for the part that is upheld) Thames Valley Police should pay Ms E £750 for distress and inconvenience.

My reasons for reaching this decision are explained in more detail below.